Central nervous system (CNS) injury is a dynamic process. The initial insult, resulting in primary neurological injury, sets into motion secondary pathological processes which compound the initial injury and adversely affect the outcome. These secondary processes include ischemia, hyperemia, edema, hypermetabolism, acidosis, inflammation and delayed hematoma formation. To optimize neurological recovery, specific methods of monitoring for and treating each of these phenomena are needed. This Program Project represents an ine=terdisciplinary research effort by the Departments of Neurosurgery, Neurology, Pediatrics and Pathology of the Baylor college of Medicine. The aim of the project is two-fold; 1) To clinically test new therapies, and systems for continuous monitoring, that have recently been developed, and 2) in a laboratory setting, to devise new therapeutic strategies for the common secondary insults associated with head injury ischemia, inflammation and delayed hemorrhages. The project consists of four related scientic proposals and three supporting Core units: Project 1: Treatment of the Hypermetabolic Response to CNS injury Aims to develop new methods of alimenting head injury patients to optimize the cerebral and systemic mulieu for neurological recovery. Project 2: Monitoring Adequacy of Cerebral Perfusion in Head-injured Patients. Development of a new method of continuously monitoring cerebral oxgenation and testing of therapeutic strategies to prevent or reverse ischemic episodes. Project 3: Continous Monitoring of intracranial Compliance by ICP Waveform Analysis. Prospective clinical testing of a system for continuous monitoring of intracranial compliance based on computerized ICP waveform analysis. Project : Reduction in CNS injury by Modification of ischemic Energy Metabolism This study aims to reduce lactic acidosis in an animal model of spinal cord ischemia. Project 5: Prevention of Hyperemia and Hemorrhage in the Newborn Brain using an animal model this project studies ways of reducing the incidence of hemorrhages in the neonatal brain Core Units. Two core units will serve all investigators in this Program Project. While approaching the problem from different viewpoints, all of these projects have a central unifying purpose - to develop and test strategies that will limit disability resulting from traumatic brain injury.